Disparities/Minority Health

Both poor and black patients are more likely to believe that a positive self-presentation can affect the quality of their medical care

Studies have repeatedly shown that whites in the United States are more likely than blacks to receive quality medical care. Other studies have shown that lower income patients, regardless of insurance coverage, have less access to care and receive lower quality of care than higher income patients. A recent study indicates that poor and black patients are more likely to present themselves as positively as they can by being friendly and wearing nice clothes to improve their chance of obtaining optimal medical care.

Researchers used data from the 2004 Greater Cincinnati Survey that asked individuals how important they thought it was to wear nice looking clothes to an appointment, to look very clean, arrive on time, be friendly with the doctor and office staff, let the doctor know that they cared about their health, and show that they were intelligent persons in order to get the best treatment possible at the doctor's office. All of these items reflect a white, middle class standard, which would most likely be similar to the doctor's culture.

Blacks, on average when compared with whites, rated positive self-presentation as more important. Those with less education and less income also rated positive self-presentation as more important than did people with more education and income. For example, an individual with a high school degree and $10,000 to $20,000 annual income rated such presentation strategies 1 point higher than a counterpart with a college degree and a $30,000 to $50,000 annual income.

Blacks' overall presentation rating was 1.3 points higher than whites, after controlling for age, gender, and insurance status. Also, increasing age and being female predicted higher ratings of the benefits of positive self-presentation. The study was supported in part by the Agency for Healthcare Research and Quality (HS13280).

More details are in "Race, socioeconomic status, and the perceived importance of positive self-presentation in health care," by Jennifer R. Malat, Ph.D., Michelle van Ryn, Ph.D., M.P.H., and David Purcell, in the May 2006 Social Science & Medicine 62, pp. 2479-2488.

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